MEDICARE PATIENTS GOING UNDER THE KNIFE TO FIX DROOPY EYELIDS HAS SKYROCKETED... AND SO HAS THE COST TO YOU. TENS OF MILLIONS OF DOLLARS... AND STILL CLIMBING. BUT NOT EVERYONE SEES EYE-TO-EYE ON WHETHER TAXPAYERS SHOULD FUND EVERY SINGLE PROCEDURE... W-D-SU ANCHOR RACHEL WULFF HAS THE STORY. 2:55 I sell police and law enforcement supplies. LAST YEAR CHALMETTE BUSINESSMAN, AL TINNEY, 9:03 you see this piece here? SET HIS SIGHTS ON IMPROVED VISION. 1:37 just sitting down in bed, looking at television or looking at something at night.. It would be if I do like this. 42 I wouldn't be able to see the rest of whatever was going on up there. 45 because the lids were actually down here, see 48 THE 77 YEAR OLD GUN ENTHUSIAST HAD TROUBLE SEEING...BECAUSE OF HEAVY FOLDS OF SKIN ON HIS EYELIDS 6:22 I had so much extra skin--you could imagine pulling this here. I could cover my eye almost. 32 SO HE WENT TO SEE A SPECIALIST--DR. KEVIN KIRSCHNER. 16:56:47 a lot of patients come in and say my mom or my dad had this..or my mom and dad needed this surgery. So certainly there is a little bit of a genetic component to that. But as we get older the collagen in the skin starts to break down and certainly gravity starts to work on us too. 58 KIRSCHNER SPECIALIZES IN EYELID LIFTS OR BLEPHAROPLASTY. 17:03:13 do you feel like your eyelids are blocking some of your vision? Yes, I do believe that. 14 WITH 200 PROCEDURES A YEAR.. IT'S THE BULK OF HIS PRACTICE. 16:57:10 medicare covers this procedure but most insurance carriers do as well... however there are certain requirements that we look at when evaluating patients for these procedures 25 PRIVATE INSURANCE COMPANIES REQUIRE KIRSCHNER -- AND OTHER DOCTORS -- TO SUBMIT FOR AUTHORIZATION OF THE PROCEDURE. THEY EVALUATE THE MEDICAL BENEFITS BEFORE GIVING THE O-K. BUT THAT'S NOT HOW IT WORKS WITH MEDICARE, WHICH -- KIRCHNER EXPLAINS -- HAS NO PRE- AUTHORIZATION REQUIREMENT FOR EYELID LIFTS.. 17:04:42 ok, I just want you looking straight ahead. SO HE MAKES EVERY CANDIDATE UNDERGO A COMPREHENSIVE EYE EXAM, A VISUAL FIELD TEST AND SUBMIT TO PHOTOGRAPHS. AND HE SAYS, "HE" TURNS PATIENTS AWAY. 16:58:14 cause it's most important to rule in who's right for the surgery and rule out who's wrong for the surgery19 3:54 I took the test and he said you're in good shape-- you're a good candidate. 56 ON AVERAGE THE SURGERY COSTS ABOUT 3000 DOLLARS. AL TINNEY PAID JUST 50 BUCKS... BECAUSE HE'S ENROLLED IN MEDICARE. 4:52 i'm glad I done it LAST YEAR, THE CENTER FOR PUBLIC INTEGRITY RAISED CONCERNS ABOUT THE WAY THE PROCEDURES WERE BEING HANDLED ... FROM 2001 TO 2011, THE REPORT NOTES EYELID LIFTS PAID FOR BY MEDICARE MORE THAN TRIPLED.....136 THOUSAND PEOPLE NOW GET THE PROCEDURE ANNUALLY... WITH AN 80 MILLION DOLLAR TAXPAYER PRICE-TAG. 00:17 it's breathtaking that you can go from 20 million to 80 million in a 10 year period..that's an amazing amount of taxpayer dollars.24 STATE REPRESENTATIVE CAMERON HENRY IS ONE OF THE MORE CONSERVATIVE MEMBERS OF THE LOUISIANA LEGISLATURE... AND HE'S BEEN A WATCHDOG WHEN IT COMES TO ANY KIND OF GOVERNMENT SPENDING... THAT MAY BE UNDER- REGULATED. HENRY UNDERSTANDS THERE IS A MEDICAL NEED FOR THE PROCEDURE ..BUT WHEN NATIONWIDE STATISTICS SHOW SOME DOCTORS PERFORMING THOUSANDS OF EYELID LIFTS PER YEAR... HE FEELS MORE MONITORING IS NEEDED.. 1:55 you just have to make sure the people who need it are getting the surgery. And the people that don't need it are not getting the surgery. 58 that's it. It's just making sure nobody is taking advantage of the system. 2:03 it seems like some doctors.. At 2200 surgeries in a year..have found a loophole and are taking advantage of the system. 2:11 and that penalizes everyone.. WE REACHED OUT TO THE GOVERNMENT AGENCY AND THEY ISSUED A STATEMENT SAYING QUOTE- GRAPHIC "The Center for Medicaid and Medicare Services takes seriously allegations of any abuse of Medicare benefits, and we have in place a series of tools to spot and stop fraud. We believe these tools, including sophisticated data analytics and stronger enrollment and screening requirements for health care providers, made possible by provisions of the Affordable Care Act, will protect the Medicare Trust Fund." LAWMAKERS SAY WITH MEDICARE ON LIFE SUPPORT AND SET TO GO BANKRUPT IN JUST OVER 10 YEARS...REFORMS CAN'T HAPPEN FAST ENOUGH. 1:43 if this continues .. Eventually you run out of money. 44 and that's kind of where we're headed 45 THESE EYELID SURGERIES ARE PERFORMED ALL OVER THE COUNTRY.. YET ACCORDING TO THE CENTER FOR PUBLIC INTEGRITY... 11 OF THE 20 HIGHEST BILLERS IN 2008 WERE IN FLORIDA ...A HAVEN FOR SENIORS AND ALSO A PLACE UNDER THE MICROSCOPE FOR QUESIONABLE MEDICARE BILLING. BACK TO YOU. THIS FOLLOWS A TREND IN TERMS OF the USE OF MEDICARE...IN 2007...925-THOUSAND DOCTORS BILLED MEDICARE FOR THEIR SERVICES... IN 2011...THAT NUMBER JUMPED TO 1-POINT-2-5 MILLION.